Loading...
HomeMy WebLinkAbout5688-zFO~ NO. 4 TOWN OF SOUTHOLD BU~.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. z~.~.~ ...... Date ........ 0c.tober. THIS CERTIFIES that the building located at .Rog~s. th~ad .............. Street Map No. ~Ldon.. Block No..L~ ...... Lot No..~ ....... ~k~utho~.d .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Ja~, '3~" ', 19.72 pursuant to which Building Permit No.. ~.5.8.8. Z.. dated .......... ~T~r~ .3! ..... , 19..~.~, was issued, mud conforms to all of the require- -~ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P~.~,v~.t.Q. g~.~g~..(~C¢.e.~OrY..b.~.d..~.g) ............................. The certificate is issued to .. K,..~.~1,2,~..1~ .t~. ................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... NR .............................. UNDERWRITERS CERTIFICATE No.. ~..R ....................................... HOUSE NUMBER ... 2~0 ....... Street .... Boger~. ~1. ........................ ....................................................... ............... ....... ...... Building Inspector FOI~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne. 5688 Z Dote ........ ~..~,.....~... ............. , 19...~....~'~ ~'}'~:~,~~ ~ ,,~ .r'>'~: ......... ~"/'~ ....... ~'" ~':"~ to ' ' .............................. ~' ....... ~-' ................... ................. ..... ....................................... ........................................ ~ ..~........~:.~,.:..:~. ........... ~~..~ .................................. TOWN OF SOUTHOLD ~/~ "~ Y~'~ '~ ~ BUILDING DEPARTMENT .~-~-,~'~.~.~ ~ ~ ~ ~ TOWN CLERK'S OFFICE [-/~ '~ / ~ ~ ~UTHOLD, N.Y. ~/~ ~,' /~ ~ ........ , ........... ~prov~ ~ ......... ~. ....... .~. ...... ,,9. ....... Pemit No...~......~.~..~;~.. ~/~ ~ . ................................................· ................. (Buildi~ I~p~r)~ ....... APPLICATION FOR BUILDING PERMIT /~ ~ ate ....... ...... INSTRUCTIONS '~ a. This application must be completely filled in by type' writer or in ,nk' and subm'tted 'in duplicate' to the' 'uilding h~ ~nspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining prem ses or pub ic streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in Whole or in part for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk COunty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remoVal or demolition, os herein described, The applicant agrees to comply with all applicable laws, ordi~ode, housing code, and regulations, (Address of applicant) State whether applicant is,~wner, I~ee, acleDtI architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premiSes ..... ~5......~~ ....... ..~..~.~.... ...................................................... If applicant is a corporate, signature of duly authorized officer. -7--~' --.~/ ~ .................. ......... F 1. Location of and on which R osed work will be one ' ap No ..... ~"~'~' ' L No ~ Street and Number ~".~,~:~ ........ ~ ~'~ ':' '~~ ......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. EXisiting use and occupancy ~..~t. £/~. ,, ............................................................................................. use and occupancy ............I;...~ .................. ..D~.../......~'L./~,.~,,.~.j~ ........................... b. Intended 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .....;..~. ........ Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. timated Cost ...... ............................... ..................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~ ....... Number of dwelling units on each floor ............................ If garage, number of c~rs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..~ ........... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~.~ ................... 'Rear ..... .~./e ................. Depth ...~:....~. ............... Height .................... Number of Stories ......... ~ ............................................................................................. 9. Size of lot: Front ..... .7...0.. ................ Rear ......... ..'~.....d.. .................. Depth ..... ./.../...~.. .................. 10. Date of Purchase ........................................................ Name F( Forrrter Owner ........................................................ !1. Zone or use district in which premises are situated ...~.~.....~ ...................................................................... 12. Does proposed construction violate ar~y ~o?.ing~. w, ordinance(~r, r. el~? ...~?.. ............................................. 13. Name of Owner of premises ~:....~........~.? .......... Addres~..~ ......................... Phone No ..................... Name of Architect ...................................................... ~ [.~. '~ AddressAddress iiiii~ii.~..iiiiiiiiiiii Phone No ..................... Name of Contractor ..... ~ ........... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEVi. ~'0]~. J,L~' t c ¢ COUN OF . ............................. ~.......~/,{:~,~:t. ...... ~..~being duly sworn, deposes and says that he is the applicant (Name bf individual signing appliF, Zitigj3) above named. He is the ............................ ..~~~ .......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this r'~ ................... ...... .............- ' ......................... Notary Public, . ........................................................... Count,,/' (Signatt~ of applicant)